Uncontrolled Non-heart-beating Donors Research Articles

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors

ObjectiveThe capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DesignThe study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 transplanted kidneys in the period 2013–2017. ScopeThe population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PatientsA total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. InterventionsCapnometry and capnography measurements in potential uncontrolled non-heart beating donors. VariablesCapnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. ResultsA total of 55 out of 74 extracted kidneys were transplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (p = 0.016) between the capnometry values during resuscitation in the grafted kidneys (µ = 22.8 mmHg) and in the kidneys discarded for transplantation (µ = 17.35 mmHg). ConclusionsCapnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the transplanted organs in uncontrolled non-heart beating donors.

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors.

The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (μ=22.8 mmHg) and in the kidneys discarded for transplantation (μ=17.35 mmHg). Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors.

Cardiovascular pathology in organ procurement from uncontrolled non-heart beating donors

Cardiovascular pathology in organ procurement from uncontrolled non-heart beating donors

Uncontrolled non-heartbeating donors (types I–II) with normothermic recirculation vs. heartbeating donors: Evaluation of functional results and survival

ObjectiveNon-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. Material and methodsA retrospective study comparing the results of 236 normothermically preserved kidneys from type I and type II NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. ResultsBoth groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0–87) for NHBDs and 38 months (range 0–90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (p=0.42) and 80.9% of DGF vs. 46.8% of HBDs (p<0.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, p=0.71) and recipients (99.1% NHBD vs. 98.6% HBD, p=0.28). ConclusionsAlthough the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.

Editorial Comment: Expanding lung donation: the use of uncontrolled non-heart beating donors

cadaver up to six hours after cardiac arrest. J Heart Lung Transplant 1999;18:582–6. [19] Wierup P, Bolys R, Steen S. Gas exchange function one month after transplantation of lungs topically cooled for 2 hours in the non-heart-beating cadaver after failed resuscitation. J Heart Lung Transplant 1999;18:133–8. [20] Steen S, Kimblad PO, Sjoberg T, Lindberg L, Ingemansson R, Massa G. Safe lung preservation for twenty-four hours with Perfadex. Ann Thorac Surg 1994;57:450–7. [21] Marasco SF, Bailey M, McGlade D, Snell G, Westall G, Oto T et al. Effect of donor preservation solution and survival in lung transplantation. J Heart Lung Transplant 2011;30:414–9. [22] Okazaki M, Date H, Inokawa H, Okutani D, Aokage K, Nagahiro I et al. Optimal time for post-mortem heparinization in canine lung transplantation with non-heart-beating donors. J Heart Lung Transplant 2006;25: 454–60. [23] Cypel M, Yeung JC, Liu M, Anraku M, Chen F, Karolak W et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med 2011;364:1431–40.

Non-Heart Beating Donor Kidney Transplantation Is not Associated with An Increased Risk of Post-Transplant Infection

Objectives: The use of kidneys from non-heart beating donors (NHBD) has increased notably over the last years. The impact of such strategy on the risk of post-transplant infection remains unclear. Methods: We performed a prospective cohort study including 225 patients (143 males; mean age: 54.4 ± 14.1 years) who underwent kidney transplant (KT) at our institution from November 2008 to August 2010. We compared the incidence and clinical and microbiological characteristics of post-transplant infection between recipients of brain-dead donor (BDD) and NHBD grafts (154 and 71 patients, respectively). NHBD belonged mostly to categories I and II of the Maastricht classification (uncontrolled donnors). All patients in the NHBD group received induction therapy with antithymocyte globulin (ATG) and antiviral prophylaxis (mainly valganciclovir) during the first 3 months. Multivariate adjusted odds ratios (ORs) for infection were calculated using those covariates found to be significant at P < 0.10 by univariate analysis. Results: As compared to patients in the BDD group, those in the NHBD group were younger (P < 0.001), had fewer years on pre-transplant dialysis (P = 0.004), shorter cold-ischemia times (P < 0.001), and higher number of HLA mismatches (P = 0.052). Delayed graft function (requirement for dialysis within the first week after transplantation) was more frequent in the NHBD group (84.5% vs. 52.6%; P < 0.001), as well as donor/recipient cytomegalovirus (CMV) mismatch (12.7% vs. 5,8%; P = 0.079). Incidence rates of overall infection in the NHBD and BDD groups were 1.94 and 3.25 episodes per 1,000 transplant-days, respectively (P < 0.0001). Incidence rate of early infection (during the first month) was also lower in the NHBD group than in the BDD group (8.4 vs. 14.12 episodes per 1,000 transplant-days, respectively; P = 0.006). Patients in the NHBD group exhibited lower cumulative incidences of bacterial infection (P = 0.044), acute graft pyelonephritis (P = 0.081), CMV infection (P = 0.016), and non-CMV viral infection (P = 0.028). We found no differences in the incidence of other types of infection. On the regression model, and after adjusting for age, induction therapy, and cold-ischemia time, among other variables, the receipt of a NHBD graft did not remain as an independent risk factor for post-transplant infection (OR 0.63; 95% CI 0.35-1.15; P = 0.191). Conclusion: In our experience, and despite the higher occurrence of delayed graft function and CMV mismatch and the universal use of ATG induction, KT from uncontrolled NHBD does not entail an increased risk of post-transplant infection.

Non-Heart Beating Donor Kidney Transplantation Is not Associated with An Increased Risk of Post-Transplant Infection

Objectives: The use of kidneys from non-heart beating donors (NHBD) has increased notably over the last years. The impact of such strategy on the risk of post-transplant infection remains unclear. Methods: We performed a prospective cohort study including 225 patients (143 males; mean age: 54.4 ± 14.1 years) who underwent kidney transplant (KT) at our institution from November 2008 to August 2010. We compared the incidence and clinical and microbiological characteristics of post-transplant infection between recipients of brain-dead donor (BDD) and NHBD grafts (154 and 71 patients, respectively). NHBD belonged mostly to categories I and II of the Maastricht classification (uncontrolled donnors). All patients in the NHBD group received induction therapy with antithymocyte globulin (ATG) and antiviral prophylaxis (mainly valganciclovir) during the first 3 months. Multivariate adjusted odds ratios (ORs) for infection were calculated using those covariates found to be significant at P < 0.10 by univariate analysis. Results: As compared to patients in the BDD group, those in the NHBD group were younger (P < 0.001), had fewer years on pre-transplant dialysis (P = 0.004), shorter cold-ischemia times (P < 0.001), and higher number of HLA mismatches (P = 0.052). Delayed graft function (requirement for dialysis within the first week after transplantation) was more frequent in the NHBD group (84.5% vs. 52.6%; P < 0.001), as well as donor/recipient cytomegalovirus (CMV) mismatch (12.7% vs. 5,8%; P = 0.079). Incidence rates of overall infection in the NHBD and BDD groups were 1.94 and 3.25 episodes per 1,000 transplant-days, respectively (P < 0.0001). Incidence rate of early infection (during the first month) was also lower in the NHBD group than in the BDD group (8.4 vs. 14.12 episodes per 1,000 transplant-days, respectively; P = 0.006). Patients in the NHBD group exhibited lower cumulative incidences of bacterial infection (P = 0.044), acute graft pyelonephritis (P = 0.081), CMV infection (P = 0.016), and non-CMV viral infection (P = 0.028). We found no differences in the incidence of other types of infection. On the regression model, and after adjusting for age, induction therapy, and cold-ischemia time, among other variables, the receipt of a NHBD graft did not remain as an independent risk factor for post-transplant infection (OR 0.63; 95% CI 0.35-1.15; P = 0.191). Conclusion: In our experience, and despite the higher occurrence of delayed graft function and CMV mismatch and the universal use of ATG induction, KT from uncontrolled NHBD does not entail an increased risk of post-transplant infection.

The Utility of Classical Parameters of Uncontrolled Non-Heart-Beating Donors to Avoid Primary Graft Dysfunction and Ischemic Cholangiopathy: Are They Still Valid?

Introduction: The acceptance of non-heart-beating donors (NHBD) emerges as a consequence of the shortage of organs and increased mortality in the waiting list. The use of these grafts implies a higher risk of primary graft dysfunction (PGD) as well as ischemic cholangiopathy (IC). Classically, liver function tests (LFT) (AST-ALT) and ischemia times, as well as the macroscopic aspect of the liver are used as determining factors in accepting these organs. Patients and methods: Between January 2006 and December 2011, we performed 380 OLT. 48 of these transplants were NHBD (Maastricht type II). We analyzed factors implied in relationship to LFT and the times with ECMO. Results: We present 48 liver recipients from uncontrolled NHBD, with a mean age of 58.1 ± 9.3 (36-71) years, and a male:female ratio of 3.8:1. The mean age of donor was 39 ± 9.3 years. The indications for transplant were: HCV infection + hepatocarcinoma (HCC) 27.1%, alcoholic cirrhosis (AC) 20.8%, HCV alone 20.8% with a total percentage of HCV of 60.4% and HCC of 43.8%. PGD was observed in 5 patients, and IC in 16. In relation to predictive factors for PGD, no statistical differences were found with respect to the mean values of cold ischemia and warm ischemia times in both groups. We also didn't find statistical differences with respect to times in ECMO, fluid flux in ECMO, nor in the transfusion of red blood cells and plasma in ECMO. No statistical differences were seen with respect to time of cardiac arrest, which paradoxically was lower in those with PGD, who also presented shorter time of cardiopulmonary resuscitation (CPR) and out-of-hospital CPR. We observed differences with respect to LFT: AST at start of ECMO: 503 U/l in PGD group vs 150 in non-PGD patients (p=0.000); ALT at the start of ECMO 462 vs 160 (p=0.000). No differences were observed with respect to total bilirrubin levels, prothrombin time (PT), activated partial thromboplastin time (aPTT) and blood pH. Considering the predictive factors for IC, no statistical differences were observed with respect to the mean values of cold ischemia times and warm ischemia times in both groups. Differences were observed with respect to a higher necessity of red blood cells in ECMO in patients with CI, although not statistically significant. No differences were observed with regard to flux parameters in ECMO, in the CPR times, nor in the analytical values. Conclusion: Taking into consideration these results, we should analyse the true value of these classical parameters in decision making, especially that only an association with elevated LFT was observed for dysfunction. Thus new parameters should be considered for the evaluation of these livers.

Clinical lung transplantation from uncontrolled non–heart-beating donors revisited

The aim of our study is to review and update the long-term results from our previously published series of lung transplantation in uncontrolled non-heart-beating donors (NHBDs). A prospective collection of data was undertaken from all lung transplants performed among uncontrolled NHBDs between 2002 and December 2009. The statistical analysis was performed using SPSS software and survival was estimated using the Kaplan-Meier method. Twenty-nine lung transplants were performed. Mean total ischemic times for the first and second lung were 575 minutes (SD 115.6) and 701 minutes (SD 111.3), respectively. Primary graft dysfunction (PGD) G1, G2 and G3 occurred in 5 cases (17%), 5 cases (17%) and 11 cases (38%), respectively. Overall hospital mortality rate was 17% (5 patients). Statistical analysis revealed a statistically significant association of mortality with ischemic times and with PGD. In terms of overall survival, 3-month, 1-year, 2-year and 5-year survival rates were 78%, 68%, 57% and 51%, respectively, and the conditional survival rates in those who survived the first 3 months were 86%, 72% and 65%, respectively. The cumulative incidence of bronchiolitis obliterans syndrome (BOS) was 11%, 35% and 45% at 1, 3 and 5 years, respectively. Lung transplantation from uncontrolled non-heart-beating donors shows acceptable results for both mid- and long-term survival and BOS; however, the higher rates of PGD and its impact on early mortality must make us more demanding with respect to the acceptance criteria and methods of evaluation used with these donors.

Hypothermic Machine Perfusion Ameliorates Ischemia-Reperfusion Injury in Rat Lungs From Non-Heart-Beating Donors

The use of non-heart-beating donors (NHBD) has come into practice to resolve the shortage of donor lungs. This study investigated whether hypothermic machine perfusion (HMP) can improve the quality of NHBD lungs. An uncontrolled NHBD model was achieved in male Lewis rats. Ninety minutes after cardiac arrest, HMP was performed for 60 min at 6°C to 10°C. The first study investigated the physiological lung functions during HMP and the lung tissue energy levels before and after HMP. The second study divided the rats into three groups (n=6 each): no ischemia group; 90-min warm ischemia+60-min HMP+120-min static cold storage (SCS) (HMP group); and 90-min warm ischemia+180-min SCS group. All lungs were reperfused for 60 min at 37°C. Lung functions were evaluated at given timings throughout the experiments. Oxidative damage during reperfusion was evaluated immunohistochemically with a monoclonal antibody against 8-hydroxy-2'-deoxyguanosine. The first study revealed that lung functions were stable during HMP. Lung tissue energy levels decreased during warm ischemia but were significantly increased by HMP (P<0.05). The second study confirmed that HMP significantly decreased pulmonary vascular resistance, increased pulmonary compliance, and improved pulmonary oxygenation. The ratio of 8-hydroxy-2'-deoxyguanosine positive cells to total cells significantly increased in the SCS group (P<0.01). Short-term HMP improved lung tissue energy levels that decreased during warm ischemia and ameliorated ischemia-reperfusion injury with decreased production of reactive oxygen species.

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 +/- 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

Present state of nonheart-beating lung donation

Indications for lung transplantation have increased through the years, and currently we have to face a lack of grafts to attend this growing demand with the subsequent increase in waiting-list deaths. Several strategies have been proposed to solve this challenging problem (living-lobe donors, extended donors, size-reduced lung grafts and so on), the use of nonheart-beating donors (NHBDs) being the most promising of them. The last experimental works concerning NHBDs have focused on the improvement of graft preservation in order to minimize warm ischemic injury and the capacity of noninvasive parameters in bronchial lavage to predict good function after implantation. There have also been several reports on the clinical use of controlled and uncontrolled NHBDs with excellent results. Several methods have been effective in protecting these grafts from ischemic damage. Functional predictors will be very useful in the near future allowing us to know in a simple and noninvasive way which grafts are suitable for transplantation. Definitely, NHBDs for lung transplantation are no more a promising source of grafts but a real one, with encouraging short-term and mid-term results.

Predicting the viability of liver allografts procured from non-heart-beating donors: The role of histopathology

Predicting the viability of liver allografts procured from non-heart-beating donors: The role of histopathology

Biliary Complications After Liver Transplantation From Maastricht Category-2 Non-Heart-Beating Donors

There are unresolved issues regarding the security of liver transplantation with non-heart-beating donors (NHBDs). Recently, an increased incidence of biliary complications, mainly intrahepatic ischemic-type biliary strictures, has been described after controlled NHBDs. We studied the incidence and risk factors for biliary complications among uncontrolled NHBDs recipients compared with a large population of HBD recipients. Overall, 16.8% of patients in the HBD group and 41.7% of patients in the NHBD group suffered any type of biliary complication (P=0.66). However, the incidence of nonanastomotic biliary strictures was significantly greater in the NHBD group (P<0.001). Multivariate analysis showed that independent risk factors for nonanastomotic strictures were hepatic artery thrombosis (relative risk; 98.7) and receiving a liver from a NHBD (relative risk; 47.1). If this type of donors is accepted as a source of liver organs, the high incidence of biliary complications should be considered and efforts should be made to decrease ischemic injury.

Results of Clinical Lung Transplant From Uncontrolled Non-Heart-Beating Donors

The scarcity of grafts for lung transplant and the growing number of candidates expecting an organ has led to an increase of deaths in patients waiting for lung transplantation. Non-heart-beating donors (NHBD) represent a promising source of grafts for those who are involved in clinical lung transplantation. We present the results of our series of 17 out-of-hospital NHBD lung transplantations performed since 2002. We have collected data from 17 donors and recipients involved in NHBD lung transplants since 2002, as well as data referring to the type of procedure and peri-operative events. We describe the incidence of post-operative complications with special attention to primary graft disfunction (PGD), bronchial healing, bronchiolitis obliterans syndrome (BOS), and survival. We used Kaplan-Meier method to obtain the survival curve. G2-G3 PGD was reported in 9 patients (53%), with a complete restoration of the partial pressure of arterial oxygen/fraction of inspired oxygen ratio in 170 hours for G2 and 168 hours for G3. There were no deaths directly related to PGD. Acute rejection was detected in 7 patients (41%), 4 of which exceeded grade 1. The incidence of BOS after transplantation was 1 (7%) of 14 patients during the first year, 2 (11%) of 9 in the second year, and 2 (50%) of 4 in the third year. Hospital mortality rate was 17%. The survival rates were 82% at 3 months, 69%, at 1 year, and 58% at 3 years. Mid-term results confirm the adequacy of uncontrolled NHBD as a promising complementary source of lung donors for clinical transplant.

Nebulized N-Acetyl Cysteine Protects the Pulmonary Graft Inside the Non–Heart-Beating Donor

The use of lungs from non-heart-beating donors (NHBD) might significantly alleviate the organ shortage. The tolerable warm ischemic period after cardiac arrest, however, is limited to approximately 1 hour. If the lung could be safely protected inside the cadaver, this time period may be prolonged. This would help to obtain family consent and to organize organ retrieval. Pigs (30.8 +/- 0.6 kg) were killed, left untouched for 3 hours, and divided into 3 groups. Nebulized N-acetyl cysteine (NAC) (300 mg), a precursor of the antioxidant agent glutathione, was administered during 10 minutes before death in Group I (NAC-NHBD, n = 6) and 15 minutes after death in Group II (NHBD-NAC, n = 6). In the control group, no aerosol was administered (NHBD, n = 6). After a warm ischemic interval of 3 hours, both lungs in all groups were topically cooled for 1 hour. Thereafter, the left lung was prepared for evaluation in an isolated reperfusion circuit. Hemodynamic, aerodynamic, and oxygenation parameters were measured. Wet-to-dry weight ratio (W/D) was calculated after reperfusion. The right lung was used to measure reduced glutathione (GSH) and oxidized glutathione (GSSG) levels (micromol/g) in lung homogenates and total protein levels in bronchial lavage fluid. Pulmonary vascular resistance, mean airway pressure, and W/D were significantly decreased in NAC-NHBD (1930 +/- 144 Dynes x sec x cm(-5), 14.2 +/- 0.5 cm H2O, and 7.4 +/- 0.4; p < 0.01, 0.01, and 0.05, respectively) and NHBD-NAC (1837 +/- 180 Dynes x sec x cm(-5), 13.3 +/- 1.2 cm H2O, and 7.3 +/- 0.3; p < 0.01, 0.05, and 0.05, respectively) when compared with the control group (5051 +/- 530 Dynes x sec x cm(-5), 17 +/- 0.4 cm H2O, 8.5 +/- 0.1, respectively). GSH/GSSG ratio was significantly higher and protein levels were significantly lower in NAC-NHBD (1.7 +/- 0.1 and 1315 +/- 60 microg/ml; p < 0.05 and 0.05, respectively) and NHBD-NAC (1.7 +/- 0.2 and 1475 +/- 159 microg/ml; p < 0.05 and 0.05, respectively) when compared with the control group (1.2 +/- 0.1 and 2150 +/- 200 microg/ml). Nebulized NAC administered before or shortly after death attenuates early ischemia reperfusion injury via upregulation of glutathione. NAC might be a promising tool to protect the pulmonary graft from both controlled and uncontrolled NHBD.

A report on the activity and clinical outcomes of renal non‐heart beating donor transplantation in the United Kingdom

The use of kidneys from non-heart beating donors (NHBDs) presents a paradox; whilst they provide more organs for transplantation, there is an increased risk of poor graft outcome, particularly in the short term. This study has highlighted the difference in early graft function and late graft survival between NHBD kidneys with short (controlled) and long (uncontrolled) warm ischaemic times. Whilst it would seem that it is preferable to use controlled donors only, their numbers are small. By employing a rational approach to the use of each of these types of kidney, such as structured viability assessment and risk analysis, it may be that the results of uncontrolled NHBD can be improved.

THE EARLY AND LONG-TERM GRAFT SURVIVALS OF CADAVERIC KIDNEYS HARVESTED FROM UNCONTROLLLED NON-HEART BEATING DONORS

73 INTRODUCTION; In this clinical communication, the early and long-term posttransplant outcome of 285 renal allografts harvested from uncontolled non-heart beating donors (NHBDs), using in situ cooling technic, and transplanted into recipients treated with ciclosporin or tacrolimus are retrospectively investigated and risk factors affecting renal prognoses are analysed. STUDY SUBJECTS AND METHODS; Between April 1979 and December 1998, 379 kidneys been retrieved from 191 uncontrolled NHBDs using in situ cooling technic at our center. Thirty five kidneys (9.2%) were discarded mainly due to poor arterial perfusion and bacterial contaminations, and 39 kidneys were transplanted into patients treated with azathioprine and steroid. Among the rest, 285 kidneys engrafted before December 1998 and transplanted into recipients treated with ciclosporin or tacrolimus were enrolled. RESULTS; Following transplants, only 46 grafts (16.1%) had immediate graft function, and 17 grafts (6.0%) were lost due to primary non-function. Two hundred twenty two grafts (77.9%) required posttransplant dialysis (PTD) for 13.7 days on the average. The mean values of posttransplant lowest serum creatinine levels (LSCR) was 1.58 mg/dl. The patient survival at one, 3, 5 and 10 years were 97.2%, 95.0%, 93.2% and 89.3%, respectively, and the graft survival at one, 3, 5 and 10 years were 83.3%, 72.0%, 64.7% and 48.6%, respectively. When the donor's age, warm ischemic time (WIT) and total ischemic time (TIT) were analyzed with the LSCR and PTD period, only the donor's age had significant correlation with LSCR and PTD period (p < 0.001 and p < 0.01, respectively). Additionaly, renal grafts from the donors died of cereblovascular disease (CVD) had significantlly higher LSCR than the grafts from non-CVD donors (P < 0.0001). When multivariate analysis was applied for the long-term graft survival, WIT (> 30 min.) and donor age (> 50 years) were significantly independent risk factors (P< 0.001 and P< 0.05, respectively). CONCLUSIONS; The renal grafts harvested from uncontrolled NHBDs using in situ cooling technic can provide good renal functions and promise an acceptable long-term graft survial. Especially when the donor is young or the cause of death is non-CVD, the posttransplant renal function and graft survival will be excellent. We conclude using the kidneys from uncontrolled NHBDs should be one of the way to resolve the severe organ shortage.